Displaying publications 21 - 40 of 128 in total

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  1. Fulltext Orthopaedic infections: organisms and antibiotic sensitivity
    Yusof MI, Yusof AH
    Med J Malaysia, 2004 Dec;59(5):574-7.
    PMID: 15889557
    Staphylococcus aureus infection remains the commonest organism causing musculoskeletal infection and antibiotic is the mainstay of treatment apart from adequate and appropriate surgical intervention. The exact figure of antibiotic resistance in orthopaedic practice is not known but it is expected to be higher than previously reported as the use of antibiotics is rampant. Its sensitivity to various antibiotics differs from one center to another making local surveillance necessary. From 66 patients with musculoskeletal infections studied in our centre, Staphylococcus aureus was cultured in 50-65% of patients, depending on the sample taken. Fifteen percent of this were methicillin resistant Staphylococcus aureus (MRSA). Staphylococcus aureus was found to be sensitive to cloxacillin in 95% of patients' sample. MRSA remained highly sensitive to vancomycin, clindamycin and fucidic acid.
    Matched MeSH terms: Surgical Wound Infection/microbiology*
  2. Fulltext Orthopaedic infections
    Choon DSK
    Med J Malaysia, 2004 Dec;59(5):571-2.
    PMID: 15889556
    Matched MeSH terms: Surgical Wound Infection/etiology*; Surgical Wound Infection/therapy*
  3. Case report post-splenectomy sepsis in thalassemic patients
    Zarina AL, Hamidah A, Zulkifli SZ, Jamal R
    Southeast Asian J. Trop. Med. Public Health, 2005 Mar;36(2):471-3.
    PMID: 15916058
    Thalassemia is the commonest hemoglobinopathy in Malaysia. Patients with thalassemia major are transfusion dependent, and a large proportion of them will require splenectomy. As this particular group of patients is immunocompromized, overwhelming sepsis is a recognized complication. We report a series of three patients who all developed intra-abdominal abscesses following splenectomy.
    Matched MeSH terms: Surgical Wound Infection/drug therapy; Surgical Wound Infection/microbiology*
  4. Appropriate antibiotic administration in elective surgical procedures: still missing the message
    Gul YA, Hong LC, Prasannan S
    Asian J Surg, 2005 Apr;28(2):104-8.
    PMID: 15851363
    OBJECTIVE: The aim of this study was to determine the appropriateness of antibiotic prophylaxis in selected elective surgical procedures in a tertiary referral centre.

    METHODS: A cross-sectional study using retrospective data from January 2000 to May 2002 was performed pertaining to elective colorectal surgery, cholecystectomy and inguinal hernia repairs. Appropriateness of antibiotic administration was determined based on compliance with national and internationally accepted guidelines on prophylactic antibiotic prescribing policy. A single dose or omission of antibiotic administration was judged appropriate for cholecystectomy and inguinal hernia repair, while up to 24 hours' dosing was considered appropriate practice for colorectal surgery.

    RESULTS: Of 419 cases, there were 55 (13.1%) colorectal procedures, 97 (23.2%) cholecystectomies and 267 (63.7%) inguinal hernia repairs. Antibiotics were administered in a total of 306 (73%) cases, with single-dose prophylaxis in only 125 (41%) of these. Prophylaxis was inappropriately prolonged in 80%, 52% and 31% of colorectal, cholecystectomy and inguinal hernia cases, respectively. The corresponding mean duration of anti-biotic administration was 2.4+/-2.2, 1.6+/-1.8 and 1.1+/-1.3 days, respectively.

    CONCLUSION: Antibiotic prophylaxis in elective surgery continues to be administered haphazardly. This study supports close surveillance of antibiotic utilization by a dedicated team, perhaps consisting of microbiologists or pharmacists, to minimize inappropriate administration.

    Matched MeSH terms: Surgical Wound Infection/prevention & control*
  5. Fulltext Sterilisation of Lucilia cuprina Wiedemann maggots used in therapy of intractable wounds
    Mohd Masri S, Nazni WA, Lee HL, T Rogayah TA, Subramaniam S
    Trop Biomed, 2005 Dec;22(2):185-9.
    PMID: 16883286 MyJurnal
    Three new techniques of sterilising maggots of Lucilia cuprina for the purpose of debriding intractable wounds were studied. These techniques were utilisation of ultra-violet C (UVC) and maggot sterilisation with disinfectants. The status of sterility was checked on nutrient agar and blood agar and confirmed with staining. The indicators for the effectiveness of the methods were sterility and survival rate of the eggs or larvae. Egg sterilisation with UVC had the lowest hatching rate (16+/-0.00%) while egg sterilisation with disinfectants showed high hatching rate (36.67+/-4.41%) but low maggot survival rate (31.67+/-1.67%). Sterilisation of the maggots was the most suitable, since the survival rate was the highest (88.67+/-0.88%). Complete sterility was achieved in all cases, except that Proteus mirabilis was consistently found. However, the presence of this microorganism was considered beneficial.
    Matched MeSH terms: Wound Infection/therapy*
  6. Fulltext Antimicrobial properties of erythromycin and colistin impregnated bone cement. An in vitro analysis
    Ruzaimi MY, Shahril Y, Masbah O, Salasawati H
    Med J Malaysia, 2006 Feb;61 Suppl A:21-6.
    PMID: 17042224
    Deep surgical site infection is a devastating consequence of total joint arthroplasty. The use of antibiotic impregnated bone cement is a well-accepted adjunct for treatment of established infection and prevention of deep orthopaedic infection. It allows local delivery of the antibiotic at the cement-bone interface and sustained release of antibiotic provides adequate antibiotic coverage after the wound closure. Preclinical testing, randomised and clinical trials indicate that the use of antibiotic-impregnated bone cement is a potentially effective strategy in reducing the risk of deep surgical site infection following total joint arthroplasty. The purpose of this study was to assess antibacterial activity of erythromycin and colistin impregnated bone cement against strains of organisms' representative of orthopaedic infections including Gram-positive and Gram-negative aerobic organisms: Staphylococcus aureus, coagulase-negative Staphylococci, Enterococcus sp., Proteus sp., Klebsiella sp., Pseudomonas sp., and Escherichia coli. Pre-blended Simplex P bone cement with the addition of erythromycin and colistin (Howemedica Inc) was mixed thoroughly with 20ml liquid under sterile conditions to produce uniform cylindrical discs with a diameter of 14mm and thickness of 2mm. 24-48 hour agar cultures of Staphylococcus aureus, coagulase-negative Staphylococci, Enterococcus sp.,Proteus sp., Klebsiella sp.,Pseudomonas sp., and Escherichia coli were used for the agar diffusion tests. The agar plates were streaked for confluent growth followed by application of erythromycin and colistin impregnated bone cement disc to each agar plate. The plates were incubated at 30 degrees C and examined at 24, 48, 72 hours, and four and five days after the preparation of the impregnated cement. The susceptibility of Staphylococcus aureus to the control discs was most clearly demonstrated showing a distinct zone of inhibition. The zone observed around coagulase-negative Staphylococci, Klebsiella sp., Pseudomonas sp., and Escherichia coli were also significant. However, there was no zone of inhibition or signs of antibacterial activity at the cemented surface were detected around discs with Enterococcus sp. and Proteus sp. The results showed that Simplex P bone cement with the addition of erythromycin and colistin was effective against most of the broad spectrum organisms encountered during total joint arthroplasty. The activity of Simplex P bone cement impregnated with erythromycin and colistin is mainly during the first 72 hours.
    Matched MeSH terms: Surgical Wound Infection/prevention & control
  7. Fulltext Biomechanical properties of bone cement with addition of cefuroxime antibiotic
    Mohd Fuad D, Masbah O, Shahril Y, Jamari S, Norhamdan MY, Sahrim SH
    Med J Malaysia, 2006 Feb;61 Suppl A:27-9.
    PMID: 17042225
    Antibiotic-loaded bone cement has been used as prophylaxis against infection in total joint replacement surgery. Its effect on the mechanical strength of cement is a major concern as high dose of antibiotic was associated with a significant reduction in mechanical strength of bone cement. However, the cut-off antibiotic that weakens the mechanical strength of cement remains to be determined. This study was undertaken to observe the changes in the mechanical properties of bone cement with gradual increments of Cefuroxime antibiotic. Cefuroxime at different doses: 0, 1.5, 3.0 and 4.5gm were added to a packet of 40gm bone cement (Simplex P) and study samples were prepared by using third generation cementing technique. Mechanical impact, flexural and tensile strength were tested on each sample. Significant impact and tensile strength reduction were observed after addition of 4.5 gm of Cefuroxime. However, flexural strength was significantly reduced at a lower dose of 3.0 gm. The maximum dose of Cefuroxime to be safely added to 40mg Surgical Simplex P is 1.5gm when third generation cementing technique is used. Further study is needed to determine whether it is an effective dose as regards to microbiological parameters.
    Matched MeSH terms: Surgical Wound Infection/prevention & control
  8. Fulltext A simple practical protocol for care of metal-skin interface of external fixation
    Saw A, Chan CK, Penafort R, Sengupta S
    Med J Malaysia, 2006 Feb;61 Suppl A:62-5.
    PMID: 17042233
    Patients treated with external fixation for limb reconsturciton or fracture stabilization equire regular and prolongedperiod of pin-tract care involving frequent visits to clinic and dressing traditionally carried out by trained nurses or medical assistants. A simple method of do-it-yourself dressing was introduced in our institution and this study was undertaken to evaluate the effectiveness of the protocol. Sixty patients (40 trauma-related problems and 20 congenital or developmental disorders) were enrolled into the study. Following application of external fixation, the patients and/or their caretakers were taught on how to do pin-site dressing using normal saline or drinking water as cleansing solution on daily basis. Patients were discharged on the second or third post-operative day and were followed-up every two weeks for an average 182 days (range 66 to 379 days) with special attention on identifying pin-tract infection. A simple grading system for pin-tract infections was proposed. Of 40 patients with trauma-related problems. 65% were post-traumatic infections. There were 788 metal-skin interfaces (239 half-pin fixations and 549 tensioned wire fixations. A total 143 metal-skin interface infections (18.1%) involving half-pin sites (41.3%) and tensioned wire sites (58.7%) was noted. Majority were grade I infections (79.7%), 18.8% grade II and only 1.4% grade III. Most infections (81%)were caused by Staphylococcus aureus. Grade I infections were successfully treated with frequent dressing, grade II by adjunctive oral antibiotic but grade III infections required removal of fixator. All eventually healed. Do yourself non-sterile dressing of metal-skin interfaces is a cost-effective method of pin-site care with a low infection rate. The infections were sucessfully treated using guidelines according to the proposed classification of pin-tract infections.
    Matched MeSH terms: Surgical Wound Infection/etiology; Surgical Wound Infection/prevention & control*
  9. Fulltext Recalcitrant post-traumatic chronic osteomyelitis/infected non-union of the tibia following open grade-ill fractures: treatment with vascularized osteocutaneous fibular graft
    Halim AS, Imran Y
    Med J Malaysia, 2006 Feb;61 Suppl A:66-70.
    PMID: 17042234
    Post-traumatic chronic osteomyelitis and infected non-unions of the tibia following severe type-III open fracture are difficult to treat Refractoy cases often necessitate amputation despite attempts to salvage the limb. We report our experience in treating such difficult cases with an alternative surgical option using free osteocutaneous fibular graft. Eight consecutive patients with post-traumatic chronic osteomyelitis/infected non-union were treated surgically with free vascularized osteocutaneous fibular graft. Outcomes in term of graft-host union and complication were evaluated. Four patients had anastomotic venous thrombosis requiring anastomotic revision. Five patients developed surgical site infections needing extended antibiotic therapy to achieve resolution at an average of 15.2 weeks. Fibular graft fracture occurred in three patients but all grafts survived and united after a mean time to union of 42.3 weeks (range 31 to 82 weeks). At the final follow-up, union of host-graft junction and control of infection were achieved in all patients except one who required a secondary amputation. Free vascularized osteo-cutaneous fibular graft is a viable limb salvage option for refractory chronic osteomyelitis or infected non-union following treatment of grade-III open tibial fractures.
    Matched MeSH terms: Surgical Wound Infection/etiology*; Surgical Wound Infection/surgery
  10. Fulltext Prophylactic antibiotics in orthopaedic surgery: guidelines and practice
    Yeap JS, Lim JW, Vergis M, Au Yeung PS, Chiu CK, Singh H
    Med J Malaysia, 2006 Jun;61(2):181-8.
    PMID: 16898309
    The national clinical practice guideline has recommended that prophylactic antibiotic be given in orthopaedic surgery involving joint replacements and internal fixation of fractures. The aim of this study is to assess the current antibiotics prophylaxis practice in a state level hospital. One hundred and three patients (68 males, 35 females; mean age 41.6 +/- 22.2 years) undergoing internal fixation for closed fractures and joint replacement surgery were included in this prospective study. The choice of pre and post-operative antibiotics, their dosages and duration of administration were recorded. The pre-operative antibiotics were only deemed to have been given if it was documented in the case notes and in the case of post-operative antibiotics if it was signed on the drug chart. Eighty eight percent were given pre-operative prophylactic antibiotics and 92% were given post-operative antibiotics. For patients undergoing internal fixation of fractures, the most commonly used antibiotic for both pre and post-op is intravenous cefuroxime. For joint replacement surgery, the most commonly used antibiotic is intravenous cefoperazone. The duration or number of doses of post-operative antibiotics was highly variable. It was not stated in 56% of the post-operative instructions. Post-operative antibiotic was ordered for 48 hours or longer in 10%. In conclusion, prophylactic antibiotics appear to be widely practised. The first line antibiotics as recommended by the present guideline were not given in any of the patients. Second generation followed by third generation cephalosporins are the most popular antibiotics, with a trend towards using third generation cephalosporins in arthroplasty patients. Single dose prophylaxis was rarely practised.
    Matched MeSH terms: Surgical Wound Infection/prevention & control*
  11. Fulltext Use of gentamicin impregnated POP discs for antibiotic pouch dressing
    Lau CP, Chee EK, Thirumal M
    Med J Malaysia, 2006 Dec;61 Suppl B:32-6.
    PMID: 17600990
    Antibiotic pouch technique is commonly used due to the high local antibiotic concentration and moist environment for wound healing. We used locally made gentamicin impregnated Plaster of Paris discs in treating wounds with exposed deep structures like tendons and bones. Out of 22 patients treated with this method, 19 completed treatment. Granulation tissue formed quickly and effectively covered the exposed structures. All wounds either healed by secondary intention or became suitable for split skin grafting. Gentamicin impregnated Plaster of Paris disc pouch dressing is safe, cost saving, and effective for management of deep open wounds.
    Matched MeSH terms: Wound Infection/therapy*
  12. Soft tissue infections in Belgian rugby players due to Streptococcus pyogenes emm type 81
    Quoilin S, Lambion N, Mak R, Denis O, Lammens C, Struelens M, et al.
    Euro Surveill, 2006 Dec 21;11(12):E061221.2.
    PMID: 17213570
    Matched MeSH terms: Wound Infection/etiology; Wound Infection/microbiology; Wound Infection/epidemiology*; Wound Infection/prevention & control
  13. Chromobacterium violaceum infection in Taiwan: a case report and literature review
    Chang CY, Lee YT, Liu KS, Wang YL, Tsao SM
    J Microbiol Immunol Infect, 2007 Jun;40(3):272-5.
    PMID: 17639170
    Chromobacterium violaceum is a facultative anaerobic, Gram-negative bacillus which inhabits stagnant water in tropical and subtropical regions. We describe the case of an 80-year-old female patient with C. violaceum bacteremia due to traumatic wound infected by contaminated water and soil. She had persistent fever, hypotension and neutrophilic leukocytosis on admission. Two sets of blood cultures yielded C. violaceum. The patient was successfully treated with levofloxacin. Since the first case from Malaysia in 1927, about 150 cases have been reported in the world literature. To our knowledge, six other cases have been reported previously from Taiwan, including two children and four adults. Of the total of seven patients from Taiwan, four had a fatal outcome within several days, while the three survivors were apparently free of vital organ involvement. Although human infections caused by C. violaceum are rare, clinicians should be aware of this potentially fatal infection as part of the differential diagnosis of sepsis associated with a history of exposure to stagnant water.
    Matched MeSH terms: Wound Infection/microbiology
  14. Frontoethmoidal encephalocele: treatment and outcome
    Arshad AR, Selvapragasam T
    J Craniofac Surg, 2008 Jan;19(1):175-83.
    PMID: 18216685 DOI: 10.1097/scs.0b013e3181534a77
    This is a study on 124 patients who were treated by the authors over a 19-year period. There were 48 male and 76 female patients. The age range of these patients at the time of treatment was between 4 months and 32 years. There was no family history of similar deformity. All of these patients come from a socially low-income group. Fourteen patients had accompanying congenital amputation of fingers, toes, or limbs. Two had oral cleft lip and palate. The surgical treatment was medial orbital wall osteotomy and excision of encephalocele. There were two mortalities and five patients who had complications that needed secondary surgical intervention. Thirty-eight patients are still under follow up without any complaints.
    Matched MeSH terms: Surgical Wound Infection/etiology
  15. Cultured epidermal autografts in combination with MEEK Micrografting technique in the treatment of major burn injuries
    Dorai AA, Lim CK, Fareha AC, Halim AS
    Med J Malaysia, 2008 Jul;63 Suppl A:44.
    PMID: 19024976
    The treatment of major burn injuries are a formidable challenge to the burn surgeon. Early aggressive surgery for deep to full thickness burn injuries is vital in the prevention of infection. The ultimate goal in major burn injuries is to prevent the onset of multi-resistant organisms and achieve early wound cover. The field of tissue engineering can help to expedite the healing of these burn wounds. The development of keratinocyte culture delivery system can be used clinically to fasten the healing process and save many lives.
    Matched MeSH terms: Wound Infection/prevention & control*
  16. Fulltext MRSA Infection in Vascular Surgical Patients: The HKL Experience
    Wong, HS, YH, William Chang, Neeta, K.B., Lum, SG, Seet, KC, Tan, HL, et al.
    Medicine & Health, 2008;3(2):294-299.
    MyJurnal
    Methicillin-resistant Staphylococcus aureus (MRSA) infection is important among vas-cular surgical patients. Its effect can be devastating resulting in limb amputation and mortality. We performed a retrospective patients record analysis to determine the pat-tern of MRSA infection among vascular surgical patients in Hospital Kuala Lumpur from January 2005 to December 2007. We also attempted to identify the factors asso-ciated with poor clinical outcome after such infection. There were 999 patients who underwent vascular surgeries in HKL within  the analysis period. Of these 24 patients (2.4%) were detected to have MRSA surgical site infection. The infection was commoner among cigarette smokers, patients with diabetes melitus and those who had previous vascular surgery. Most infections occurred in the emergency surgery category and manifested as wound breakdown. Fifty-four percent of the infected pa-tients ended with graft removal, amputations or death. MRSA infection complicating vascular surgery resulted in poor clinical outcome. This serious threat requires intensi-fied preventive measures.
    Matched MeSH terms: Surgical Wound Infection
  17. Fulltext Local antibiotics are equivalent to intravenous antibiotics in the prevention of superficial wound infection in inguinal hernioplasty
    Praveen S, Rohaizak M
    Asian J Surg, 2009 Jan;32(1):59-63.
    PMID: 19321405 DOI: 10.1016/S1015-9584(09)60011-7
    Antibiotic prophylaxis for inguinal hernioplasty is still practiced in many hospitals to prevent consequences of infected mesh, mesh removal and hernia recurrence. The common route of administration is intravenous. However this method can be associated with systemic side effects. Alternatively, locally applied antibiotics have been used and proven to significantly reduce the infection rate after inguinal hernioplasty.
    Matched MeSH terms: Surgical Wound Infection/prevention & control*
  18. Diluted povidone-iodine versus saline for dressing metal-skin interfaces in external fixation
    Chan CK, Saw A, Kwan MK, Karina R
    J Orthop Surg (Hong Kong), 2009 Apr;17(1):19-22.
    PMID: 19398787
    To compare infection rates associated with 2 dressing solutions for metal-skin interfaces.
    Matched MeSH terms: Surgical Wound Infection/epidemiology; Surgical Wound Infection/prevention & control*
  19. Antibiotic prophylaxis tailored to local organisms reduces percutaneous gastrostomy site infection
    Mahadeva S, Sam IC, Khoo BL, Khoo PS, Goh KL
    Int J Clin Pract, 2009 May;63(5):760-5.
    PMID: 19222613 DOI: 10.1111/j.1742-1241.2008.01881.x
    Current recommendations for the choice of antibiotic prophylaxis prior to percutaneous endoscopic gastrostomy (PEG) insertion may not be suitable in all situations.
    Matched MeSH terms: Surgical Wound Infection/prevention & control*
  20. Fulltext The prevalence and risk factors of nosocomial Acinetobacter blood stream infections in tertiary teaching hospital in north-eastern Malaysia
    Deris ZZ, Harun A, Omar M, Johari MR
    Trop Biomed, 2009 Aug;26(2):123-9, 219-22.
    PMID: 19901898
    Acinetobacter spp. is a known nosocomial pathogen causing a wide range of clinical diseases mainly pneumonia, wound infections and blood stream infections (BSI). A cross sectional descriptive study was performed to determine the prevalence of Acinetobacter infection in Hospital Universiti Sains Malaysia, Kelantan (HUSM). The risk factors of Acinetobacter BSI were determined by 1:1 case control analytical study, involving fifty-eight confirmed cases of Acinetobacter BSI patients compared to the cases caused by Gram-negative bacteria. The prevalence of Acinetobacter BSI in the HUSM was 6.11% (95% CI 4.88-7.53%). The attack rate of Acinetobacter BSI was 2.77 episodes per 1000 hospital admissions. Acinetobacter BSI patients were mostly located in intensive care unit and had a longer intensive care unit stay. In univariate analysis, the risk factors for Acinetobacter BSI include prior exposure to antimicrobial agents such as penicillins, aminoglycosides and cephalosporins, mechanical ventilation, presence of nasogastric tube, arterial catheter and urinary catheter. In multivariate analysis, the independent risk factors for Acinetobacter BSI were prior treatment with cephalosporins (OR 3.836 95% CI 1.657-8.881 p=0.002) and mechanical ventilation (OR 3.164 95% CI 1.353-7.397 p=0.008). This study revealed that rational use of antimicrobial agents is of paramount importance to control Acinetobacter BSI.
    Matched MeSH terms: Wound Infection/microbiology
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